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Apart from the well-known role of hypertension in cerebrovascular disease, visit-to-visit blood pressure (BP) variability is emerging as an independent risk factor for stroke. Although the underlying mechanism is not fully understood, artery remodeling is thought to be closely involved in the relationship between visit-to-visit BP variability and stroke. This review article summarizes the recent literature on these topics. Silent cerebral injury is considered to serve as a common pathophysiology in the relationship of visit-to-visit BP variability with cognitive impairment and stroke. Here we review visit-to-visit BP variability, some comparisons of the effects of antihypertensive agents on visit-to-visit BP variability, and an issue regarding the impact of these agents on stroke. [ABSTRACT FROM PUBLISHER]

BACKGROUND Recent studies have shown that short and long sleep durations and insomnia are associated with increased home-measured blood pressure (BP) variability, which in turn has a relationship with arterial stiffness. However, the determinants for visit-to-visit systolic blood pressure (SBP) variability have rarely been investigated in relation to sleep duration, insomnia, and carotid arterial stiffness. METHOD The subjects were 201 elderly individuals (79.9±6.4 years old) with one or more cardiovascular risks. Based on 12 visits, visit-to-visit BP variability (expressed as a coefficient of variation [CV]) and δ (maximum − minimum) BP were measured. Self-reported sleep duration and insomnia questionnaires were used to classify the patients according to sleep duration period and insomnia status. RESULTS After multivariable adjustment, long sleep duration (≥ 9 hours per night) had significant positive associations with SBP δ (P < 0.05), while persistent insomnia had significant positive associations with SBP CV (P < 0.05) and δ (P < 0.01). Additionally, significant interactions were found in terms of long sleep duration by carotid artery stiffness parameter β (P < 0.05), persistent insomnia by intima-media thickness (P < 0.01), and persistent insomnia by stiffness parameter β (P < 0.05) for SBP δ. CONCLUSION In elderly patients at high risk for cardiovascular disease, long sleep duration as well as persistent insomnia were significantly associated with higher visit-to-visit BP variability. Long sleep duration and persistent insomnia each had synergetic interactions with carotid artery stiffness and with visit-to-visit BP variability. [ABSTRACT FROM AUTHOR]

Although hypertension is well known as a cause of vascular dementia (VaD), recent findings highlight the role of hypertension in the pathogenesis of Alzheimer's disease (AD) as well as mild cognitive impairment (MCI). Recent studies have shown that disruption of diurnal blood pressure (BP) variation is closely associated with cognitive impairment via injury of the small cerebral arteries indicating that long-standing hypertension constitutes a risk of brain matter atrophy or white matter lesions (WMLs). In several clinical trials, BP-lowering with antihypertensive agents was suggested to reduce the risk of dementia or cognitive decline. This review paper focuses on the role of hypertension as a risk factor for cognitive impairment, and summarizes current knowledge on the relationships between ambulatory BP monitoring (ABPM) and cognitive impairment. Finally, an overview of the impact of antihypertensive therapy on dementia prevention is provided.American Journal of Hypertension 2010; doi:10.1038/ajh.2009.212 [ABSTRACT FROM AUTHOR]

BackgroundInsular cortex (Ic) has been suggested to be a key site in limbic–autonomic integration. Association of Ic damage with disruption of diurnal blood pressure (BP) variation and higher serum level of noradrenaline has been reported. We examined the relationships of Ic volume with ambulatory BP measures and noradrenaline concentration.MethodsAmbulatory BP monitoring and brain magnetic resonance imaging (MRI) were performed in 55 elderly never-treated hypertensives. Ic volumes were measured using an intensity contour mapping algorithm. Serum adrenaline and noradrenaline concentrations were evaluated.ResultsSubjects were classified into an Ic-atrophy group (n = 14) and non-Ic-atrophy group (n = 41) based on a total Ic volume (left and right side) of 12.6 cm3 (lowest quartile). In the Ic-atrophy group, 24 h (145 mm Hg vs. 134 mm Hg, P < 0.05) and sleep (143 mm Hg vs. 127 mm Hg, P < 0.01) systolic BP (SBP) and nocturnal SBP dipping (1.30% vs. 8.54%, P < 0.05) were significantly different, and noradrenaline (373 pg/ml vs. 296 pg/ml, P = 0.08) was marginally different from those in the non-Ic-atrophy group. Left Ic volume was significantly correlated with 24 h (r = −0.277) and sleep (r = −0.499) SBP and nocturnal SBP dipping (r = 0.413), while right Ic volume was significantly correlated with 24 h (r = −0.261) and sleep (r = −0.430) SBP, nocturnal SBP dipping (r = 0.321) and noradrenaline (r = −0.335). In multiple linear regression analysis adjusted for age, gender and body mass index (BMI), left Ic volume was significantly negatively associated with sleep SBP (P < 0.01) and positively with nocturnal SBP dipping (P < 0.05).ConclusionIc atrophy, specifically in the left side, may partly contribute to disruption of diurnal ambulatory BP rhythm via central autonomic nervous system (ANS) dysregulation.American Journal of Hypertension 2009; doi:10.1038/ajh.2009.71American Journal of Hypertension 2009; 22, 7, 723–729. doi:10.1038/ajh.2009.71 [ABSTRACT FROM AUTHOR]

In this article the authors discuss points that should be addressed when interpreting the findings of a study which examined the relationship between blood pressure (BP) and brain atrophy in patients with vascular disease. They explore the use of prospective study design to evaluate their association. They also relate the findings of epidemiologic studies which revealed that hypertension is associated with the development of impaired cognitive function, vascular dementia and Alzheimer's disease.

Background: Short sleep duration has been shown to be associated with cardio/cerebrovascular disease. White matter hyperintensities (WMH) have been associated with an increased risk of stroke. In addition to high ambulatory blood pressure (BP), chronic kidney disease (CKD) is a risk for WMH. In this study, we investigated the relationships among sleep duration, CKD, and WMH in elderly hypertensives., Methods: Ambulatory BP monitoring and brain magnetic resonance imaging were performed in 514 Japanese elderly hypertensives (mean age 72.3 years, males 37%). WMH cases were further divided into deep subcortical white matter lesion or periventricular hyperintensity (PVH). CKD (n = 193) was defined as estimated glomerular filtration rate less than 60 ml/min/1.73 m(2)., Results: According to sleep duration (<7.5, ≥7.5 to <9.5, and ≥9.5 hour per night), significant associations of sleep duration were observed with WMH and PVH. In the regression analysis including age, gender, smoking, antiplatelet agents use, 24-hour systolic BP, nondipper, white coat hypertension and CKD, short sleep duration was significantly positively associated with WMH and PVH when subjects with mid-range sleep duration were used as a reference group. A significant interaction was found between short sleep duration and CKD for PVH. In the non-CKD group, short sleep duration had strong significant positive associations with WMH and PVH., Conclusions: In the present study, short sleep duration was a positive significant determinant for WMH and PVH in elderly hypertensives. Sleep duration might serve as a strong determinant for white matter lesions especially in those without CKD., (© American Journal of Hypertension, Ltd 2015. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)